Many women recognize subtle signs that their period is about to start. An uptick in chocolate cravings, unexplained crankiness and fatigue are common symptoms of premenstrual syndrome (PMS) that typically come and go relatively quickly. But for others, these symptoms are anything but subtle.

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A small perce women (3-9 percent) have premenstrual dysphoric disorder (PMDD), a medical condition that causes intense physical and emotional symptoms beginning up to two weeks before menstruation starts.

How do PMS and PMDD symptoms compare?

As with PMS, symptoms of PMDD vary from woman to woman. They may include irritability, bloating, breast tenderness, headaches, and sleep changes. The major difference between PMS and PMDD is the severity of symptoms.

PMS is typically uncomfortable, but tolerable. With PMDD, the symptoms are often so troublesome they can disrupt your job and personal relationships, says psychiatrist Lilian Gonsalves, MD.

Diagnosing PMDD

Physicians diagnose PMDD through symptom tracking.

It’s important to keep a calendar detailing your symptoms and when they occur. This allows a physician to see patterns and ensure that mood changes aren’t occurring at other times of the month, says women’s health specialist Holly L. Thacker, MD, Director of Cleveland Clinic’s Center for Specialized Women’s Health and executive director of Speaking of Women’s Health.

“Typically, a physician will have you track symptoms for three months with a menstrual and symptom calendar before making a diagnosis,” she says.

If symptoms happen at other times, your physician will likely want to rule out other potential causes such as depression, a thyroid disorder, or alcohol or substance misuse, Dr. Gonsalves says.

Tips to ease symptoms

Here are six tips for making changes that may help you ease or better manage PMDD symptoms:

1. Get more exercise. Aerobic exercise is particularly helpful.

2. Get adequate sleep. The National Sleep Foundation recommends getting seven to nine hours each night.

4. Avoid stress. Avoid scheduling potentially stressful appointments or events around PMDD bouts whenever possible. For instance, don’t plan for a vacation or schedule stressful meetings at work in the week or two before you expect your period.

5. Practice mindfulness. Mindfulness training may help reduce stress through meditation or breathing exercises. This may improve mood and sleep for some women, Dr. Gonsalves says.

6. Take supplements. Get enough calcium, correct any low vitamin D and take a daily balanced B5 complex vitamin supplement to help alleviate mood symptoms, Dr. Thacker says. Eat omega 3 at least twice a week by eating fish, nuts, and chia and flax seeds. Avoid alternative treatments like chasteberry or St. John’s Wort, which have mixed results and lack U.S. Food and Drug Administration approval.

Medical treatment options

If lifestyle modifications don’t control PMDD symptoms, there are a medical options:

2. Antidepressants. The PMDD gold-standard is Prozac® (fluoxetine), Dr. Gonsalves says. You may use this intermittently — during the two weeks before your period — or all month, depending on your response to treatment, she says.

3. Lupron shots. If PMDD is severe enough, your physician may recommend up to six months of Lupron® shots, which prematurely put you into menopause. This can sometimes stop PMDD symptoms.

4. Hysterectomy. In rare, extreme cases, your physician may recommend a hysterectomy. If you’ve had children and no other treatment works, it may be a consideration, Dr. Gonsalves says.

If extreme symptoms are disrupting your life for a week or more every month, don’t just try to gut it out alone. Talk to your doctor about ways to ease your PMDD.